This is exactly what the story (linked below…) in the ultra-conservative Wall Street Journal on Tuesday, February 9, 2010 is talking about: Insurance companies (in this case, UnitedHealthcare) deciding who gets what (cancer) treatment – not the doctors, and certainly not the patient.

It’s all based on what the insurance company costs are, not the health of the patient.

In the article, the insurance company sends "reports" to doctors and hospitals and "suggests methods" to "trim cancer treatment costs" – and to not necessarily follow the "medical protocol" for the type of cancer to be treated.

http://online.wsj.com/article/SB10001424…

Read it and weep. We’re already there: Insurance companies "suggesting" limited treatment plans. Insurance companies directing medical care. What if it was your mother, father, brother or sister or your husband or wife being required to take a substandard treatment regimen to save the insurance company money?

And, least we forget – we’re all grown-ups here (supposedly). Try READING the article PRIOR TO COMMENTING.

Thanks kiddies…

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http://online.wsj.com/article/SB10001424052748703357104575045261652218880.html

Maybe this link will work better…

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"INSURER PLAYS JUDGE ON CANCER CARE", by Avery Johnson 02-09-2010, WSJ

UnitedHealthcare, a unit of the nation’s largest health insurer based on revenues, has started sending doctors individualized reports assessing their treatment of breast, lung and colorectal cancer patients. The reports show that while breast-cancer patients generally receive care that conforms to professional protocols, treatments given for colorectal and lung cancer tend to fail to meet expert recommendations more often.

Cancer is UnitedHealthcare’s third-most-expensive disease, at a cost of .5 billion a year, after cardiovascular disease and orthopedic joint procedures. The company says its goal is not to rank or reward medical practitioners. Rather, it hopes that drawing doctors’ attention to how their treatments might vary from medical protocol will reduce unnecessary care that doesn’t improve health and raises health-care cost
UnitedHealthcare and other insurers have programs in place to track medical treatments that are easier to measure than cancer is. For example, WellPoint Inc., the country’s largest insurer by number of members, has a pay-for-performance program in primary care that rewards physicians based on technology adoption and generic-drug use. But insurers have been slow to target cancer treatment and its costs, in part because of the disease’s complexity and how it can affect patients so differently.

"Oncology has always been the third rail for managed care," says Lee Newcomer, Unitedhealthcare’s senior vice president of oncology. "Insurance companies have been very reluctant to get involved in cancer care because any management might be perceived as denial."

Some critics say that monitoring quality is not the appropriate role for an insurer, which has a financial interest in all this. "This is one area I’d rather have doctors police themselves than have an insurance company do it," says Eric
says Eric Winer, chief scientific adviser for Susan G. Komen for the Cure, a research and educational organization.

The American Society of Clinical Oncology, a professional organization, has been running its own quality-assessment program, in which doctors’ performances are measured against national guidelines. The group is seeking to enlist the help of insurers to expand the number of participating physicians. One company that has signed on is Blue Cross Blue Shield of Michigan, which pays doctors to help defray the administrative costs of submitting their clinical data to the program a few times a year.

Cancer-treatment quality has been particularly hard to track because claims information tells insurers relatively little about the patient. The data often don’t make clear, for instance, if a breast-cancer patient is in remission or relapse. The differences in the disease’s stage are uniquely important for cancer, since tumors change over time, necessitating different treatments.
So for the past three years, UnitedHealthcare has been collecting clinical information directly from oncologists. The company then compared the choices that a doctor made for a particular patient’s treatment with claims data and guidelines developed by the National Comprehensive Cancer Network, a consortium of 21 leading treatment centers. In November, the company mailed the individual reports to 1,321 oncologists.

The company especially probed the use of high-price biotech drugs, which it says it found in some cases are being prescribed inappropriately. One NCCN guideline for colon-cancer patients advises that patients get chemotherapy after surgery, but in 31% of cases, the care did not comply with the rule. Instead, in the bulk of those cases, patients were prescribed Avastin, a Roche Holding AG biologic that is unproven in that patient group, says Dr. Newcomer. And among patients with non-small-cell lung cancer, about 24% received Avastin, even though their disease didn’t meet the

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Filed under: Medical Health Insurance Plans

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